As Canada’s population ages, frailty – with its increased risk of functional decline, deterioration in health status, and death – will become increasingly common. The physiology of frailty reflects its multisystem, multi-organ origins. About a quarter of Canadians over age 65 are frail, increasing to over half in those older than 85. Our health care system is organized around single-organ systems, impairing our ability to effectively treat people having multiple disorders and functional limitations. To address frailty, we must recognize when it occurs, increase awareness of its significance, develop holistic models of care, and generate better evidence for its treatment. Recognizing how frailty impacts lifespan will allow for integration of care goals into treatment options. Different settings in the Canadian health care system will require different strategies and tools to assess frailty. Given the magnitude of challenges frailty poses for the health care system as currently organized, policy changes will be essential.

Continuing education is the ideal mechanism to allow retired people to maintain their autonomy and health for as long as possible. Despite the importance of education in the development of human beings, very few studies have been identified on the need for continued education in older adults. This quantitative descriptive study allowed us to better understand the interests and the needs of seniors related to continuing education in French-speaking older adults in New Brunswick (n = 408), and to identify the perceptions of participants with regard to the benefits, the challenges and the preferences of seniors for continuing education. Study results indicate that the main interests of participants were for training in technology (computers), gardening and health matters. Given the lack of research in this domain, these results will be useful for future planning of continuing education initiatives for seniors.

This study explored qualitatively how residents of long-term care (LTC) facilities feel about and adapt to the care they receive. We interviewed and observed a purposeful selection of elderly residents in seven facilities purporting to provide person-centred care. Interpretative descriptions from 43 personal interviews with 23 participants answered the question: How do residents perceive the care rendered in LTC facilities purporting to offer person-centred care? Three themes emerged: (1) the caring environment; (2) preservation of dignity; and (3) maintenance of personal autonomy. Participants were sympathetic to the nursing staff’s workload, but felt distant from the staff. Participants gave examples of poor care and lack of empathy, human indignities, and violations of personal autonomy caused by institutional policies they felt inhibited their ability to receive care based on their preferences. Overall, they challenged the claims of person-centred care, but adapted to cope with an environment that threatened their dignity and autonomy.

Quality of life and well-being of older patients in chronic care facilities is often determined by their relationships with nurses. The authors developed and tested a scale to assess patients’ views of what matters most when relating to nurses. Based on the humanistic nursing theory by Paterson and Zderad (1988), 69 items were created and tested with a sample of 40 patients, resulting in refinement of a scale with 24 items. This scale was factor analysed on responses from 249 patients residing in five facilities in Ontario, Canada. The Humanistic Relationship Importance Scale demonstrated strong internal consistency, stability, and reliability with a five-factor solution (α = .87). Construct validity was supported through factual identification. This scale is a valid measure of patients’ perspectives of a nurse-patient relationship in chronic care and can be used to measure health professionals’ relationships with their older patients and evaluate interventions to enhance relational care.

Employing a participatory arts-based research approach, we examined an innovative program from rural Ontario, Canada, designed to address social isolation among older people. Older socially isolated adults were matched to trained volunteers, where in dyads, the eight pairs created expressive art in their home setting over the course of 10 home visits. With thematic and narrative inquiry, we analysed the experiences and perceptions of the program leader, older participants, and older volunteers via their artistic creations, weekly logs, evaluations, and field notes. The findings reveal a successful intervention that positively influenced the well-being of older adult participants and older volunteers, especially in regards to relationships, personal development, and creating meaning as well as extending the intervention’s impact beyond the program’s duration. We also discuss opportunities for similar programs to inform policy and enable positive community-based health and social service responses to rural social isolation.

This qualitative study describes expectations, concerns, and needs regarding long-term care (LTC) homes and home care services of 12 older lesbian and gay couples living in Canada. Our findings reflect four major themes: discrimination, identity, expenditure of energy, and nuanced care. Discrimination involved concerns about covert discrimination; loss of social buffers as one ages; and diminished ability to advocate for oneself and one’s partner. Identity involved anticipated risk over disclosing one’s sexual identity; the importance of being identified within a coupled relationship; and the importance of access to reference groups of other gay seniors. We conclude that partners were burdened by the emotional effort expended to hide parts of their identity, assess their environments for discrimination, and to placate others. Nuanced care involved a mutual level of comfort experienced by participants and their health care providers. These themes inform understandings of LTC homes and home care services for lesbian and gay older couples.

The aim of this study was to explore policies and procedures to support employees who retire from the emergency services. Interviews were conducted with participants who were familiar with existing policies and procedures in a large ambulance (n = 8) and fire (n = 6) service in Ireland. Four key themes were identified: (1) “I don’t think it’s a job at 65 to be running out on an emergency ambulance”; (2) “They do genuinely feel a wee bit isolated”; (3) improving the “cultural shock”; and (4) “I just keep going and hope for the best”. Findings point towards retirement as a major life change and highlight a need for more structured, effective pre-retirement preparation. Factors unique to emergency service personnel include the physical and emotional stress involved in emergency service; a strong identification with the service; and a lack of clarity about rules and entitlements, requiring better information and preparation.

We investigated the effect of background noise on performance on the Montreal Cognitive Assessment (MoCA). Two groups of older adults (one with clinically normal hearing, one with hearing loss) and a younger adult group with clinically normal hearing were administered two versions of the MoCA under headphones in low and high levels of background noise. Intensity levels used to present the test were customized based on the hearing abilities of participants with hearing loss to yield a uniform level of difficulty across listeners in the high-level noise condition. Both older groups had poorer MoCA scores in noise than the younger group. Importantly, all participants had poorer MoCA scores in the high-noise (M = 22.7/30) compared to the low-noise condition (M = 25.7/30, p < .001). Results suggest that background noise in the test environment should be considered when cognitive tests are conducted and results interpreted, especially when testing older adults.

With an increasing number of older drivers who are prescribed antidepressants, the potential consequences of antidepressant use on driving skills in an aging population are becoming a pressing issue. We conducted a systematic review using MEDLINE, targeting articles specifically pertaining to antidepressants and driving in a population or subgroup of older adults (≥ 55 years of age). The search yielded 267 references, nine of which pertained to the effects of antidepressants on driving in older adults. The single experimental study found imipramine to have detrimental effects on highway driving, whereas nefazodone did not. Seven of eight population-based studies reported a significant increased risk of involvement in a collision associated with antidepressant use. Although the studies indicated a negative effect of antidepressants on driving, the epidemiological designs cannot exclude the possibility that the underlying illness, generally major depression, is the culprit.

Ontario has the highest proportion of for-profit nursing homes in Canada. These facilities, which are known in Ontario as long-term care (LTC) homes, offer 24-hour custodial as well as nursing care to individuals who cannot live independently. Increasingly, they are also operating as members of multi-facility chains. Using longitudinal data (1996–2011) from the Residential Care Facilities Survey (n = 627), our analysis revealed discernible differences in staffing levels by profit status and chain affiliation. We found for-profit LTC homes – especially those owned by a chain organization – provided significantly fewer hours of care, after adjusting for variation in the residents’ care needs. Findings from this study offer new information on the impact of organizational structure on staffing levels in Ontario’s LTC homes and have implications for other jurisdictions where a growing presence of private, chain-affiliated operators has been observed.

Heart failure (HF) affects up to 20 per cent of residents in long-term care (LTC) and is associated with substantial morbidity, mortality, and health service utilization. Our study objective was to formulate recommendations on implementing HF care processes in LTC. A three-phase and iterative stakeholder consultation process, guided by expert panel input, was employed to develop recommendations on implementing care processes for HF in LTC. This article presents the results of the third phase, which consisted of a series of interdisciplinary workshops. We developed 17 recommendations. Key elements of these recommendations focus on improving interprofessional communication and improving HF-related knowledge among all LTC stakeholders. Engaging frontline staff, including personal support workers, was stated as an essential component of all recommendations. System-level recommendations include improving communication between LTC homes and acute care and other external health service providers, and developing facility-wide interventions to reduce dietary sodium intake and increase physical activity.

Our research is interested in understanding how the elderly evaluate their past, so the aims of this study are, first, to understand if there are age differences within the older population in terms of positivity effect, and second, to test if perception of happiness and vulnerability are two independent recall systems. To test our hypotheses, we used the Vivre / Leben / Vivere survey on a population of 65 years and older (n=4200), in Switzerland. Findings show that happiness depends on social and cultural norms, while there is an age effect for vulnerability. For happiness, there are no age differences, but this is not the case for vulnerability: the oldest age groups are less likely to report episodes of vulnerability during most of their lives.

Homelessness among older people is a growing concern across Canada and is expected to rise with demographic change (Crane & Warnes, 2010; Culhane, Metraux, Byrne, Stino, & Bainbridge, 2013). Yet current knowledge, policies, and practices on homelessness largely focus on younger populations. Likewise, research and policies on aging typically overlook homelessness. Responses to homelessness among older people must address complex needs related to health, income security, and housing. Based on a comprehensive literature review, this article outlines the existing and needed research with regards to homelessness among older people. We clarify the intersections of aging and homelessness; review the relevant statistics, including estimated prevalence; discuss pathways and variations in experience; and identify gaps in knowledge. We conclude with a call for an inclusive research agenda that will help build policies and practices to reduce and ultimately to eliminate homelessness among older people in Canada.

This article explores potential differences in yoga practice between middle-and older-aged adults. A health belief – life course model frames this research, and a mixed-methods analytic strategy is employed to examine life course pathways into yoga and motivations to practice, as well as perceived barriers and health benefits. For the quantitative analyses, a convenience sample of 452 participants was collected using an online questionnaire. For the qualitative analyses, face-to-face interviews were conducted with a sub-set of 20 participants. Unique differences between the age groups (both current age and age when started yoga) as well as by gender were found for selected pathways, reasons/motivations, and barriers to engage in yoga as well as for perceived health benefits. In addition, results underscore the importance of informational cues and social linkages that affect how individuals adopt and experience yoga. Implications for health promotion programs that target older adults are discussed.

Few studies have focused on falls among home care (HC) clients with neurological conditions. This study identified factors that increase risk of falling among HC clients with no recent history of falls, and explored whether risk profiles varied among those with dementia or parkinsonism compared to those without selected neurological conditions. A retrospective cohort design was used and analysis of data from community-based HC clients across Ontario was conducted on a sample of ambulatory clients with dementia, parkinsonism, or none of the selected neurological conditions. Data were obtained from the Resident Assessment Instrument for HC (RAI-HC) assessment. The outcome used in multivariable analyses was whether clients fell during follow-up. Unsteady gait was a strong predictor of falls across all three groups. Co-morbid parkinsonism most strongly predicted falls in the dementia group. Clients with borderline intact to mild cognitive impairment had higher odds of falling within the parkinsonism and comparison groups.

This research examines obstacles faced by older people living with HIV in maintaining their significant social ties (family, friends) in the light of a double theoretical framework, inter-sectionality and the course of life. Favoring a qualitative methodology, this research is based on in-depth, semi-directed interviews with a diverse sample of 38 people living with HIV, aged 50-73 years. Analysis reveals that a significant proportion of participants have experienced ruptures or deterioration of close ties with intimates at the level of family or friends. The principal factors behind these difficulties are the past and present stigma associated with HIV and /or other social positions, long-term effects of HIV, issues related to aging and crosscutting effects of HIV and aging.

This study examined a cohort of 227 older drivers and investigated the relationship between performance on the electronic Driver Observation Schedule (eDOS) driving task and: (1) driver characteristics; (2) functional abilities; (3) perceptions of driving comfort and abilities; and (4) self-reported driving restrictions. Participants (male: 70%; age: M = 81.53 years, SD = 3.37 years) completed a series of functional ability measures and scales on perceived driving comfort, abilities, and driving restrictions from the Year 2 Candrive/Ozcandrive assessment protocol, along with an eDOS driving task. Observations of participants’ driving behaviours during the driving task were recorded for intersection negotiation, lane-changing, merging, low-speed maneuvers, and maneuver-free driving. eDOS driving task scores were high (M = 94.74; SD = 5.70) and significantly related to participants’ perceived driving abilities, reported frequency of driving in challenging situations, and number of driving restrictions. Future analyses will explore potential changes in driving task scores over time.

Social participation, a key determinant of healthy aging, is often negatively impacted by age-related vision loss (ARVL). This grounded theory study aimed to understand social participation as a process negotiated in everyday life by older adults with ARVL. Interviews, audio diaries, and life space maps were used to collect data with 21 older adults in two Ontario cities. Inductive data analysis resulted in a transactional model of the process of negotiating social participation in context. This model depicts how environmental features and resources, skills and abilities, and risks and vulnerabilities transacted with values and priorities to affect if and how social participation occurred within the context of daily life. The findings point to several ways that research and services addressing the social participation of older adults with ARVL need to expand, particularly in relation to environmental features and resources, risk, and the prioritization of independence.